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PubMed1987

Idiopathic scoliosis: foundation for physiological treatment.

The three-dimensional nature of the idiopathic spinal deformity has been investigated in cadaveric specimens and patients with both idiopathic scoliosis and idiopathic kyphosis (Scheuermann's disease). In both scoliotic and kyphotic deformities the essential lesion lies in the sagittal plane with apical vertebral wedging. In idiopathic scoliosis there is an apical lordosis which being biomechanically unstable rotates to the side to produce a scoliotic deformity as a secondary component. In contradistinction the kyphotic wedging process of Scheuermann's disease is mechanically stable and any associated idiopathic type scoliosis occurs above and below the region of kyphosis. When an asymmetric lordosis is created in the growing New Zealand white rabbit, a progressive lordoscoliosis is readily produced and when the thoracic kyphosis is restored the scoliotic deformity shows evidence of regression and this forms the basis of physiological treatment. In 25 patients with idiopathic thoracic scoliosis the thoracic kyphosis has been restored and this leads to enhanced correction of the deformity in all three planes.

Adolescent↗
PubMed1987

[Syringomyelia and scoliosis in children and adolescents. Apropos of 14 cases].

The authors report their experience of 14 cases of scoliosis in children or young adults in association with syringomyelia. The neurological lesion was discovered at a variable time during the development of the scoliosis which may appear to be idiopathic for several years. There were 11 cases of syringomyelia or hydromyelia and three intramedullary tumours with cyst formation. The neurological lesion must be treated first and sufficiently early to avoid the development of muscle weakness and scoliosis. The scoliosis can be treated by normal without risk of additional complications.

Adolescent↗
PubMed1986

Ventilatory patterns during hypoxia, hypercapnia, and exercise in adolescents with mild scoliosis.

Adolescents with mild, asymptomatic scoliosis (thoracic curvature less than 35 degrees) may have little or no impairment of resting lung volumes. Progression to more severe disease may, however, be accompanied by lung restriction, impaired exercise tolerance, and respiratory failure with CO2 retention. We wished to see whether adolescents with mild scoliosis and minimally abnormal resting pulmonary mechanics had impairment of their responses to hypercapnia, hypoxia, and progressive cycle exercise. Forty-four adolescents with idiopathic scoliosis were studied. The mean forced vital capacity (FVC), expressed as a percentage of the predicted value, was 94.3 +/- 2.2 (SE). The mean ventilatory response to hypercapnia (2.57 +/- 0.24 L/min/mm Hg) was within the normal range but was achieved with a tidal volume response (1.87 +/- .17% vital capacity [VC]/mm Hg) that was significantly lower than that previously reported in healthy young adults. Ventilatory responses to exercise were also within the normal range, the mean dyspnea index (VE-max/maximal voluntary ventilation) = 0.92 +/- 0.04. However, at a ventilation of 30 L/min, the tidal volume was 0.38 +/- 0.01% FVC, which was considerably lower than predicted. The tidal volume response to hypoxia was also abnormally low, the mean response being 0.52 +/- 0.059% VC/% decrease in arterial O2 saturation. These findings indicated that, even when scoliosis is asymptomatic and associated with minimal impairment of resting pulmonary function, abnormal patterns of ventilation occur during exercise or in response to chemical stimuli.

Adolescent↗
PubMed1986

[The significance of the lumbosacral curve in idiopathic scoliosis].

The purpose of this study is to clarify the role of the lumbosacral curve in idiopathic scoliosis from several points of view. Cases with idiopathic scoliosis were radiologically analysed in the frontal plane, in the horizontal plane with CT-scan and in the sagittal plane, and the relationship of these dimensional deformites in the lumbosacral junction was studied. These findings were also contrasted with the severity, the pattern and the chronological changes of the main curve above. From the results it can be said that the lumbosacral curve is not necessarily a compensatory curve, but may play a more positive role in the formation of the curve pattern of the entire spine. Generally, the lumbosacral junction of thoracic scoliosis was less mobile than that of lumbar and double major cases. It was difficult, however, to predict the potential progress of a mild scoliosis from the attitude of the lumbosacral junction.

Adolescent↗
PubMed1985

[Research for the prevalence of scoliosis].

The number of scoliotic patients under treatment have recently showed a marked increase in Japan. In this situation, the author has raised two important questions. Firstly, has the incidence of scoliosis increased in Japan? Secondly, what happened to scoliotic patients who had been left untreated before the establishment of the current therapy. To seek answers for these questions, prevalence studies for all generations were carried out. As to the first question, the prevalence rate of scoliosis in adult from the twenties to forties was lower than in junior high and high school students. From this incidence and other several factors, the author concluded that the incidence of scoliosis in Japan increased recently. As to the second question, questionnaires were sent to each patients subjected to the secondary examination. Since the difference between scoliotic group and control group on the back symptoms did not appear significant, scoliosis and subjective symptoms apparently failed to show a correlation.

Adolescent↗
PubMed1986

Natural history of scoliosis in Friedreich's ataxia.

Does scoliosis associated with Friedreich's ataxia behave like an idiopathic or a typical neuromuscular scoliosis? Should it be treated like an idiopathic or a neuromuscular curve? Since no precise information to answer these questions could be found in the orthopaedic literature, a retrospective study was undertaken of seventy-eight patients with Friedreich's ataxia who had been followed at our neuromuscular clinic. Fifty-six of these patients were found to have typical Friedreich's ataxia in accordance with the criteria of Geoffroy et al., and their cases were retained for analysis. Their mean age was twenty years (range, eight to thirty-three years). The average length of clinical follow-up was nine years and the average duration of radiographic follow-up of the scoliosis was 3.5 years. A scoliosis of more than 10 degrees was found in all patients and was associated with a hyperkyphosis in 66 per cent. Both sexes were equally affected. Fifty-seven per cent of the curves were double thoracic and lumbar; 14 per cent were thoracolumbar; 7 per cent, double thoracic and thoracolumbar; 7 per cent, thoracic; 4 per cent, lumbar; and 11 per cent, multiple small curves. Of the fifty-six patients whose cases were studied, thirty-six had been followed for at least ten years. Among these thirty-six, there were twenty whose curves were more than 60 degrees and progressed (Group I) and sixteen whose curves were 40 degrees or less and did not progress (Group II).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Structural scoliosis in osteoporotic women.

Fifty women (mean age 69 +/- 5 years) with biopsy-proven osteoporosis and back pain were radiographically studied for scoliosis, kyphosis, and compression fractures. Twenty-four (48%) osteoporotics had at least 10 degrees of structural scoliosis. Curves were indistinguishable from those of idiopathic scoliosis. Lumbar and thoracolumbar curves were most common. The kyphosis averaged 70 degrees +/- 17 degrees and spanned 9.8 +/- 1.75 vertebrae. Forty-seven patients had 140 compression fractures. Fractures occurred within, but were usually not the cause of, scoliotic curves. Scoliosis in elderly women is a clinical marker and may be a risk factor for osteoporosis and compression fractures. Adult scoliotic patients should be evaluated for osteoporosis with iliac bone biopsies and aggressively treated.

Aged↗
PubMed1985

Early diagnosis of scoliosis based on school-screening.

A total of 8165 schoolchildren were screened for scoliosis by two teams of orthopaedic surgeons using the same procedures and criteria. Of 790 children who had positive physical signs, 689 were examined roentgenographically. Using 5 and 10 degrees as cut-off points, the prevalence of scoliosis was 6.58 and 2.4 per cent, respectively. A follow-up study of children who had been reported to have scoliosis at the age of eleven months showed that only half of them actually had scoliosis.

Adolescent↗
PubMed1979

Reconstructive surgery in the adult for failed scoliosis fusion.

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients. The two-stage procedure consisted of exposure of the spine and multiple osteotomies, followed by two weeks of halofemoral traction to obtain correction. The spine fusion was then extended, using Harrington instrumentation to maintain correction. At an average follow-up of 3.3 years there was reduction of pain in 67 per cent of the patients and a solid fusion in all but two. The complication rate was high (71 per cent), the most important complications being pseudarthrosis, wound infection, urinary tract infections, loss of lumbar lordosis, and pressure sores. The mortality rate was 3.4 per cent. No patient became paraplegic at the initial surgical procedure and early recognition and treatment of pseudarthrosis will reduce the number of patients requiring this salvage operation.

Adult↗
PubMed1983

[Prognosis of extensive vertebral arthrodesis for scoliosis using Harrington's rods. Initial evaluation].

The authors have studied the technical results and the social status of patients operated on for scoliosis with Harrington rods. Only 137 of the first 330 patients, now adults, could be located and questioned. The scoliosis was idiopathic in nearly all cases. Correction of angulation was comparable to that found in the international literature. The aesthetic results were fair. Most of the patients are still young, and lead active lives without any noticeable loss of function or discomfort, except for low back pain whose frequency is discussed. Scoliosis, therefore, is thought to influence the social and professional future of these patients very little. Their problems have been analysed by the use of a questionnaire. The follow-up period for this early assessment is still short and needs to be completed by a further review in 10 to 15 years. It is likely that these results will not then be applicable to scoliosis of the future whose management will be likely to have altered.

Adult↗
PubMed1984

The biomechanics of scoliosis.

A review of the epidemiology of scoliosis reveals that it is costly in human suffering and health care resources. The terminology is defined and classifications explained. The full geometric description of scoliosis includes the three-dimensional description of the vertebral column, as well as the rib cage. Stereoradiographic and stereophotogrammetric (Raster and Moire) techniques are introduced. The coupling in a kinematic sense between, for example, lateral bend and rotation is compared to the orientation coupling in scoliosis. Genetic, biochemical, hormonal, neurological, and mechanical factors do not as yet explain the etiology. Column buckling models do not incorporate coupling, especially that occurring in scoliosis and thus do not improve our understanding of the deformity or its progression.

Adolescent↗
PubMed1978

Scoliosis: incidence and natural history. A prospective epidemiological study.

A prospective study was carried out of the incidence and natural history of adolescent idiopathic scoliosis in 26,947 students. Data were obtained on 1,122 students with idiopathic scoliosis. The incidence of idiopathic scoliosis was 4.5 per cent. The female-to-male ratio was 1.25:1.0 over-all, but the ratio varied directly with the severity of the curve--that is, 1:1 for curves of 6 to 10 degrees, and 5.4:1 for curves of more than 20 degrees. Progression of the curve was determined by a two-year follow-up of 603 patients. Progression was observed in 6.8 per cent of the students and in 15.4 per cent of the skeletally immature girls with scoliosis of more than 10 degrees at the initial examination. In 20 per cent of the skeletally immature children with curves of 20 degrees at the initial examination, there was no progression. Spontaneous improvement of the curve occurred in 3 per cent and was seen more frequently in curves milder than 11 degrees. Treatment was required in 2.75 students per 1,000 screened.

Adolescent↗
PubMed1983

Adult scoliosis.

Adult scoliosis is a complex and difficult area of modern orthopaedics. Thanks to modern techniques of both operative and nonoperative care, treatment is now possible for problems thought of as impossible only a few years ago. Most adult scoliosis problems require a great depth of evaluation and decision making before arriving at the best form of treatment. Failure to do these necessary steps can lead to monumental problems. Nonoperative treatment of painful curves is best done with orthotics and not with physiotherapy. The operative procedure of choice for most patients is posterior instrumentation and fusion, striving for stabilization and pain improvement, not dramatic curve or cosmetic change. Pain is usually significantly improved but is almost never totally eliminated. Special procedures, such as anterior correction and fusion as well as combined anterior and posterior procedures, are appropriate only for very special problems. The complication rate for adult scoliosis surgery is far higher than for children and adolescents and usually increases with age. Surgeons should not attempt treatment of adults until thoroughly competent in the treatment of adolescent scoliosis.

Adult↗
PubMed1982

Voluntary school screening for scoliosis in Minnesota.

School screening for scoliosis is a well accepted technique for the early detection of spinal deformities. We reviewed the experience in Minnesota over the past eight years, with an average of one-quarter of a million children being screened yearly. Of the children screened, 3.4 per cent were referred for evaluation and scoliosis was found in 1.2 per cent. The number of children requiring operations for adolescent idiopathic scoliosis has diminished since 1970. The average curve for which a surgical procedure was done has also diminished from 60 to 42 degrees. The cost of the program is low, averaging 6.6 cents per student screened. This compares with a so-called time cost averaging thirty-five cents. Voluntary scoliosis screening in Minnesota is an efficient and cost-effective program.

Adolescent↗
PubMed1982

The influence of lung volume on gas transfer in scoliosis.

Single-breath carbon monoxide transfer factor (DLCO) and diffusion coefficient (KCO) have been compared with vital capacity and total lung capacity in 119 subjects with scoliosis, 74 with idiopathic scoliosis, 32 with congenital osteogenic scoliosis and 13 with paralytic scoliosis. In each group mean values of DLCO were below, and for KCO above, predicted values. Furthermore, in each group, DLCO was correlated with lung volume and KCO inversely correlated with lung volume. The reduction in DLCO is probably due to the reduction in the total alveolar surface area and the increased values for KCO probably result from an increase in pulmonary capillary blood volume per unit alveolar volume at low lung volumes.

Adolescent↗
PubMed1978

Pain provoked scoliosis. Observations on the evolution of the deformity.

The case reports of 5 children with scoliosis provoked by painful vertebral lesions of osteoid osteoma and eosinophilic granuloma reveal that the final outcome of the deformity is determined by the interaction of 2 factors: the age of the child (in relation to his growth velocity); the duration of symptoms. Complete resolution in 2 children with scoliosis of 10 months' and one year's duration respectively, and partial regression of a curve which has been present for 6 years in another child draws attention to the fact that spontaneous correction of structural scoliosis can and does occur in a growing child. In the light of this and other evidence it is suggested that early idiopathic scoliosis could possess the potential for spontaneous correction.

Adolescent↗
PubMed1981

The changing pattern of scoliosis treatment due to effective screening.

We evaluated the effects over a ten-year period of a program for early detection and treatment of idiopathic scoliosis in a stable population of 1.5 million people. Seven hundred and twenty-five patients with a scoliosis of more than 20 degrees (as measured with Cobb's method) and who were twenty years old or younger were followed during this period. Although treatment principles remained essentially the same, the percentage of patients who required an operation each year decreased. The magnitude of the ten most severe curves detected each year decreased from an average of 64 degrees to 44 degrees. Efforts to detect scoliosis early have resulted in a threefold increase in the number of patients treated for scoliosis.

Adolescent↗
PubMed1981

Scoliosis caused by benign osteoblastoma of the thoracic or lumbar spine.

We are reporting the cases of five patients with scoliosis caused by a benign osteoblastoma of the thoracic or lumbar spine. All five patients had pain and scoliosis as the presenting symptoms, which had lasted from six months to two years. The average curve measurement was 49 degrees. Two patients were treated by excision of the lesion, posterior spine fusion, and Harrington instrumentation and three, by excision of the lesion only. At follow-ups ranging from two and one-half to five years after treatment (average, three years and eight months), no patient had pain or recurrence of the tumor. The scoliosis was improved in the three patients who had been symptomatic for nine months or less and who had undergone excision of the tumor. The scoliosis did not improve in the two patients whose symptoms had been present for longer periods of time.

Adolescent↗